HHH Direct Deposit Authorization Form

Home, Hope and Healing Inc.
Authorizations for Direct Deposits - Employee Form
Account #1
Account Type
Bank Name
Amount of Deposit $
Account Number
Bank Routing Number (ABA#)
Account #2
Account Type
Bank Name
Amount of Deposit $
Account Number
Bank Routing Number (ABA#)
Employee will receive a paper check until a prenote has verified the account number(s) with the employee’s bank. Once verified, funds will be paid using direct deposit.

This authorization will be in effect until HOME, HOPE AND HEALING, INC. receives a written termination notice from me and has a reasonable opportunity to act on it.
Employee Name (Please Type Here):
Signature (sign with curser):
Enter the message as it's shown*
Document is Date/Time stamped when you click "Submit"
Should be Empty:

Home, Hope and Healing Inc.